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Logo of bmcpediBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Pediatrics
 
BMC Pediatr. 2012; 12: 106.
Published online Jul 24, 2012. doi:  10.1186/1471-2431-12-106
PMCID: PMC3447641
Evaluation of splanchnic oximetry, Doppler flow velocimetry in the superior mesenteric artery and feeding tolerance in very low birth weight IUGR and non-IUGR infants receiving bolus versus continuous enteral nutrition
Valentina Bozzetti,corresponding author1 Giuseppe Paterlini,1 Valeria Meroni,1 Paola DeLorenzo,2,3 Diego Gazzolo,4 Frank Van Bel,5 Gerard HA Visser,5 MariaGrazia Valsecchi,2,3 and Paolo E Tagliabue1
1Department of Neonatal Intensive Care, MBBM Foundation, San Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
2Department of Clinical and Preventive Medicine, Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza, Italy
3Department of Pediatrics, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
4Department of Maternal, Fetal and Neonatal Medicine, C. Arrigo Children’s Hospital, Alessandria, Italy
5Department of Neonatology, Wilhelmina Children’s Hospital, AB, Utrecht, Netherlands
corresponding authorCorresponding author.
Valentina Bozzetti: vbozzetti/at/hotmail.com; Giuseppe Paterlini: g.paterlini/at/hsgerardo.org; Valeria Meroni: vale.meroni/at/gmail.com; Paola DeLorenzo: paola.delorenzo/at/unimib.it; Diego Gazzolo: dgazzolo/at/hotmail.com; Frank Van Bel: F.vanBel/at/umcutrecht.nl; Gerard HA Visser: g.h.a.visser/at/umcutrecht.nl; MariaGrazia Valsecchi: grazia.valsecchi/at/unimib.it; Paolo E Tagliabue: p.tagliabue/at/hsgerardo.org
Received May 18, 2012; Accepted July 6, 2012.
Abstract
Background
IUGR infants are thought to have impaired gut function after birth, which may result in intestinal disturbances, ranging from temporary intolerance to the enteral feeding to full-blown NEC.
In literature there is no consensus regarding the impact of enteral feeding on intestinal blood flow and hence regarding the best regimen and the best rate of delivering the enteral nutrition.
Methods/design
This is a randomized, non-pharmacological, single-center, cross-over study including 20 VLBW infants.
Inclusion criteria
* Weight at birth ranging: 700–1501 grams
* Gestational age up to 25 weeks and 6 days
* Written informed consent from parents or guardians
Exclusion criteria
* Major congenital abnormality
* Patients enrolled in other trials
* Significant multi-organ failure prior to trial entry
* Pre-existing cutaneous disease not allowing the placement of the NIRS’ probe
In the first 24 hours of life, between the 48th and 72nd hours of life, and during Minimal Enteral Feeding, all infants’ intestinal perfusion will be evaluated with NIRS and a Doppler of the superior mesenteric artery will be executed.
At the achievement of an enteral intake of 100 mL/Kg/day the patients (IUGR and NON IUGR separately) will be randomized in 2 groups: Group A (n=10) will receive a feed by bolus (in 10 minutes); then, after at least 3 hours, they will receive the same amount of formula administered in 3 hours. Group B (n=10) will receive a feed administered in 3 hours followed by a bolus administration of the same amount of formula (in 10 minutes) after at least 3 hours.
On the randomization day intestinal and cerebral regional oximetry will be measured via NIRS. Intestinal and celebral oximetry will be measured before the feed and 30 minutes after the feed by bolus during the 3 hours nutrition the measurements will be performed before the feed, 30 minutes from the start of the nutrition and 30 minutes after the end of the gavage. An evaluation of blood flow velocity of the superior mesenteric artery will be performed meanwhile. The infants of the Group A will be fed with continuous nutrition until the achievement of full enteral feeding. The infants of the Group B will be fed by bolus until the achievement of full enteral feeding.
Discussion
Evaluations of intestinal oximetry and superior mesenteric artery blood flow after the feed may help in differentiating how the feeding regimen alters the splanchnic blood flow and oxygenation and if the changes induced by feeding are different in IUGR versus NON IUGR infants.
Trial registration number
NCT01341236
Keywords: Feeding tolerance, Near infrared spectroscopy, Minimal enteral feeding, Enteral nutrition, Parenteral nutrition, Intra-uterine growth restriction, Near infrared spectroscopy, Mesenteric artery Doppler, Bolus nutrition, Intermittent nutrition
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